DHS – Managed care organizations (MCO) contract information, forms and resources

Care coordination: A service provided by a care coordinator. The primary focus of care coordination is to promote health and wellness, provide education and manage chronic conditions. The goal of care coordination is to meet the person’s health needs by coordinating efforts across different providers and services. For older adults on the Elderly Waiver (EW), the care coordinator also provides case management services.

A care coordinator must be one of the following qualified professionals:

For Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+), all care coordinators (except physician assistants, nurse practitioners and physicians acting as care coordinators for people in nursing facilities) must be certified assessors. They provide both the assessment and ongoing case management functions for enrolled people, including support planning services.

To be eligible for care coordination, a person must be enrolled in one of the following programs:

For program eligibility requirements, refer to CBSM – Minnesota Medical Assistance (MA) managed care programs.

Once a person is enrolled in MSHO, MSC+ or SNBC, the MCO will assign a care coordinator.

A care coordinator works with the person to:

Care coordination services cannot duplicate other Minnesota state plan or waiver services.

People age 65 and older

Elderly Waiver (EW)

People who are enrolled in MSHO or MSC+ and request EW or state plan services receive these services through the care coordinator. The care coordinator will take the following actions:

A single staff member serves as the certified assessor, case manager and care coordinator and is responsible to coordinate the care the person receives. The MCO is responsible for payment of services.

People who live on or near the White Earth, Leech Lake, Red Lake, Mille Lacs or Fond du Lac reservations may be able to choose to get their EW services through the tribal health or human services division or through the MCO. Contact the tribal nation or the MCO with questions.

Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waivers

People who are enrolled in managed care (MSHO, MSC+) and request a disability waiver (BI, CAC, CADI, DD) receive waiver services through a county or tribal nation. The county or tribal nation will take the following actions for the disability waiver:

The county or tribal nation fulfills the roles of the certified assessor and case manager. They coordinate the care with the MSHO or MSC+ care coordinator.

If the county or tribal nation fulfills the role of the case manager and care coordinator for a person receiving BI, CAC, CADI or DD waiver services, they have what is considered a “dual role.” The county or tribal nation is responsible for the above actions, and they also complete the staying healthy section in the MnCHOICES assessment as a delegate of the MCO. For more information, refer to the section about billing when in a dual role below.

People younger than age 65

People who are enrolled in managed care (SNBC or Families and Children) and request a disability waiver (BI, CAC, CADI, DD) receive waiver services through a county or tribal nation. The county or tribal nation will take the following actions for the disability waiver:

The county or tribal nation fulfills the roles of the certified assessor and case manager, and they coordinate the care with the SNBC care coordinator.

If the county or tribal nation fulfills the role of the case manager and care coordinator for a person receiving BI, CAC, CADI or DD waiver services, they have what is considered a “dual role.” The county or tribal nation is responsible for the above actions, and they also complete the staying healthy section in the MnCHOICES assessment as a delegate of the MCO. For more information, refer to the section about billing when in a dual role below.